Membership/Gift Membership/Memorial Form - print, fill out and mail to: 
Brown Cty. Humane Society, Box 512, New Ulm, MN  56073  Make checks payable (do not send cash) to BCHS

Name:___________________________________________________________

Address:_________________________________________________________

City:___________________ State:___ Zip Code:_______________

Phone:_________________   E-Mail:_______________________

( ) I want to become a Brown County Humane Society Member

_____$2 Children 12 and under _____$5 Student

_____$10 Individual _____$15 Family

( ) This is a gift membership for________________________________________________________

( ) I want to provide financial support. Donation enclosed.

( ) This is a people memorial in memory of_____________________________

( ) This is a pet memorial in memory of ___________________the pet of __________________________

( ) dog ( ) cat ( ) other______________________________

( ) This is in honor of ______________________________________________

( ) I want to volunteer.   ( )Please call me.  ( )Please E-mail me.  

I am interested in: ( ) foster home ( ) fund raising ( ) newsletter

( ) other, please specify: __________________________________

( ) I do not want to volunteer. Please do not call me.

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